Project Summary The growth of national health care expenditures is unsustainable, reaching a staggering $2.9 trillion in 2013 (8). Surgical expenditures are estimated to account for 29% of costs and consume 1/14th of our nation's Gross Domestic Product (GDP) by 2025 (2, 3). Time in the operating room is extremely costly, with estimates as high as $100 per minute(4). Surgical supplies alone represent up to 50% of operating room expenses(14). Historically, there has been little incentive to contain costs, but with the introduction of the Affordable Care Act (ACA), reimbursements are now linked to a diagnosis or a procedure, rather than individual components of a patient's care(10). This shifts the burden of reducing expenses to health care providers who must now deliver high quality care on a fixed income. The Agency for Healthcare Research and Quality (AHRQ), in particular, has an interest in evaluating, optimizing, and delivering valuable healthcare under this new framework. Surgeons have a direct impact on the cost of a patient's care as they pre-select items used for cases and open additional instruments as the operation progresses. It is common for a single surgical implant to cost thousands of dollars. Despite this, research describing intraoperative expenses is rare (16). This proposal seeks to remedy this information gap by (I) calculating surgeon-specific intraoperative costs for common general surgery operations across several academic hospitals, (II) identifying factors that drive these expenses, and (III) developing and implementing an intervention aimed to reduce these expenses. This project will retrospectively analyze electronic medical record (EMR) and hospital accounting data to determine average surgeon-expenditures for several common operations across multiple institutions. Multiple logistic regression analysis will identify the impact of patient and surgeon factors on costs. Semi-structured interviews of focus groups will shape development of the intervention. This will be followed by a six-month implementation phase and prospective analysis of the intervention's efficacy and feasibility. Results of this study will inform hospitals and health care systems about the relative costs of items used in their operating rooms and the factors driving these expenses. Importantly, it will introduce a methodology for institutions to analyze their own expenses and provide a generalizable, structured intervention that can be adapted for their use.